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OBJECTIVES@#To evaluate the feasibility and safety of bipolar-plasmakinetic transurethral enucleation and resection of the prostate (B-TUERP) in day surgery.@*METHODS@#From January 2021 to August 2022, 34 patients with benign prostatic hyperplasia (BPH) underwent B-TUERP in day surgery in the First Affiliated Hospital of Anhui Medical University. Patients completed the screening and anesthesia evaluation before admission and received the standard surgery which implements "anatomical enucleation of the prostate" and "absolute bleeding control" on the same day of admission, and by the same doctor. Bladder irrigation was stopped, catheter was removed and the discharge evaluation was performed on the first day after operation. The baseline data, perioperative conditions, time of recovery, treatment outcomes, hospitalization costs, and postoperative complications were analyzed.@*RESULTS@#All operations were successfully conducted. The average age of the patients was (62.2±7.8) years, average prostate volume was (50.2±29.3) mL. The average operation time was (36.5±19.1) min, the average hemoglobin and blood sodium were decreased by (16.2±7.1) g/L and (2.2±2.0) mmol/L, respectively. The average postoperative length of hospital stay, and total length of hospital stay were (17.7±2.2) and (20.8±2.1) h, respectively, and the average hospitalization cost was (13 558±2320) CNY. All patients were discharged on the day after surgery except for one patient who was transferred to a general ward. Three patients received indwelling catheterization after catheter removal. The 3-month follow-up results showed a substantial improvement in the International Prostate Symptom Score, quality of life score and maximum urinary flow rate (all P<0.01). Three patients experienced temporary urinary incontinence, 1 patient experienced urinary tract infection, 4 patients were diagnosed with urethral stricture and 2 patients experienced bladder neck contracture. No complications above Clavien grade Ⅱ occurred.@*CONCLUSIONS@#The preliminary results showed that B-TUERP ambulatory surgery is a safe, feasible, economical and effective treatment for appropriately selected patients with BPH.
Subject(s)
Male , Humans , Middle Aged , Aged , Prostate/surgery , Prostatic Hyperplasia/surgery , Ambulatory Surgical Procedures , Quality of Life , Feasibility Studies , Retrospective Studies , Treatment OutcomeABSTRACT
Enhanced recovery after surgery (ERAS) measures have not been systematically applied in transurethral surgery for benign prostatic hyperplasia (BPH). This study was performed on patients with BPH who required surgical intervention. From July 2019 to June 2020, the ERAS program was applied to 248 patients, and the conventional program was applied to 238 patients. After 1 year of follow-up, the differences between the ERAS group and the conventional group were evaluated. The ERAS group had a shorter time of urinary catheterization compared with the conventional group (mean ± standard deviation [s.d.]: 1.0 ± 0.4 days vs 2.7 ± 0.8 days, P < 0.01), and the pain (mean ± s.d.) was significantly reduced through postoperative hospitalization days (PODs) 0-2 (POD 0: 1.7 ± 0.8 vs 2.4 ± 1.0, P < 0.01; POD 1: 1.6 ± 0.9 vs 3.5 ± 1.3, P < 0.01; POD 2: 1.2 ± 0.7 vs 3.0 ± 1.3, P < 0.01). No statistically significant difference was found in the rate of postoperative complications, such as postoperative bleeding (P = 0.79), urinary retention (P = 0.40), fever (P = 0.55), and readmission (P = 0.71). The hospitalization cost of the ERAS group was similar to that of the conventional group (mean ± s.d.: 16 927.8 ± 5808.1 Chinese Yuan [CNY] vs 17 044.1 ± 5830.7 CNY, P =0.85). The International Prostate Symptom Scores (IPSS) and quality of life (QoL) scores in the two groups were also similar when compared at 1 month, 3 months, 6 months, and 12 months after discharge. The ERAS program we conducted was safe, repeatable, and efficient. In conclusion, patients undergoing the ERAS program experienced less postoperative stress than those undergoing the conventional program.
Subject(s)
Male , Humans , Prostatic Hyperplasia/complications , Quality of Life , Transurethral Resection of Prostate/adverse effects , Treatment Outcome , Enhanced Recovery After SurgeryABSTRACT
Objective:To assess whether urinary incontinence after holmium laser enucleation of the prostate (HoLEP) is associated with membranous urethral length(MUL)on preoperative magnetic resonance imaging.Methods:The data of 96 patients who underwent HoLEP from January 2019 to April 2021 in Peking University Third Hospital were retrospectively analyzed. For all patients, the average age was (70.0±7.7) years old, the average body mass index was (23.9±2.9)kg/m 2, median pre-biopsy PSA was 3.79(2.48, 6.03)ng/ml, the average prostatic volume was (60.5±35.0)ml. 22 patients(22.9%) suffered with diabetes mellitus, and 17 patients(17.7%)had at least one time urinary retention. MUL was measured on MRI as the vertical distance from prostatic apex to the entry of the urethra into the penile bulb. All patients' median MUL was 13(11, 17)mm. The recovery of continence was followed up 2 weeks after HoLEP. The difference of age, body mass index, preoperative PSA, diabetes mellitus, urinary retention, prostate volume and MUL between urinary continence and incontinence group 2 weeks after HoLEP operation. The variables with P<0.1 were included in multivariable logistic regression to analyze the independent risk factors of urinary incontinence after HoLEP were compared. Results:All operations were successfully completed. The continence returned to normal in 72 cases (75.0%) and urinary incontinence existed in 24 cases (25.0%) in 2 weeks after surgery. There were 27 cases (37.5%) in continence group and 16 cases (66.7%) in incontinence group for those aged≥70 years. 21 cases (29.2%) in continence group and 13 cases (54.2%) in incontinence group had prostate volume ≥ 60 ml. There were 30 cases (41.7%) in continence group and 20 cases (83.3%) in incontinence group with MUL<13 mm. χ 2 test showed that age ( P=0.013), prostate volume ( P=0.027) and MUL ( P<0.001) were related to the incontinence after surgery. The age, prostate volume and MUL were included in the multivariate logistic regression analysis. Multiple logistic regression showed that MUL<13 mm( P<0.001) was independent predictor for incontinence after HoLEP. Conclusions:The incidence of urinary incontinence was high 2 weeks after HoLEP. Short MUL, which is less than 13 mm, is significantly associated with delayed recovery of urinary continence after HoLEP.
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【Objective】 To evaluate the efficacy and safety of 450 nm semiconductor blue laser combined with triamcinolone acetonide injection in the treatment of bladder neck contracture (BNC). 【Methods】 A 61-year-old male patient with BNC and urethral stricture was treated with 450 nm semiconductor blue laser vaporization combined with triamcinolone acetonide injection. The surgery was performed with a small-caliber laser resectoscope of F22. The follow-up results 3 months after surgery were reported. 【Results】 The operation was successful, the operation time was 30 minutes, and the patient was discharged the next day after operation. Follow-up 3 months after operation showed the maximum urinary flow rate (Qmax) was 22.1 mL/s, the International Prostate Symptom Score (IPSS) was 2, the Quality of Life Scale (QoL) was 0, and no recurrence was observed. 【Conclusion】 It is safe and feasible to use 450 nm semiconductor blue laser combined with triamcinolone acetonide injection to treat bladder neck contracture through a small-caliber laser resectoscope of F22, especially for patients with urethral stricture. The short-term efficacy is satisfactory.
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Objective To evaluate the safety and efficacy of bipolar transurethral plasmakinetic enucleation of the prostate (PKEP) with PKRP for benign prostatic hyperplasia (BPH) with prostate volumes over 80 ml.Methods A total of 78 patients of BPH with prostate volume more than 80 ml were retrospectively analysed to either PKEP (n =41) or PKRP (n =37).All patients were assessed preoperatively and followed up of clinic at the 3rd,6th,and 12 th month postoperatively.Baseline characteristics of the patients,intraoperative events (operation time,bleeding volume),postoperative events (bladder irrigation time,catheter time) and postoperative effect evaluation (IPSS score,QOL score and Qmax) were recorded.t test was used for measurement data expressed by ((x) ± s) among groups.And chi-square test was used for Enumeration data expressed by rate(％) between the two groups.Results The operation time,the decrease of hemoglobin,irrigation time and the catheter time in the PKEP and PKRP were (100.7 ±31.2),(150.1 ±30.3) min,(1.1 ±0.5),(2.1 ±0.8) g/dl,(16.9 ±4.3),(31.8 ± 8.3) h,(33.4 ± 11.2),(51.7 ± 18.6) h,respectively.Those indexes in the PKEP group were significantly better than those in the PKRP group (P ＜ 0.05).The baseline values and postoperative outcome indices of PKEP group at the 3rd,6th,and 12 th month were IPSS (28.01 ± 5.31),(15.01 ± 3.62),(8.01 ±2.30),(7.83±2.11)、QOL(4.5 ±0.8),(3.5 ±0.6),(1.3 ±0.4),(1.1 ±0.5)、Qmax(6.21 t2.09),(13.24 ± 2.31),(15.33 ± 2.44),(17.65 ± 3.21) mL/s,residual urine volume (75.02 ± 25.21),(10.87 ±6.16),(10.55 ± 5.21),(9.97 ± 5.63) ml.All the indices after 3 months of operation were improved compared with baseline values (P ＜ 0.05).The incidence of complications in PKEP group (17.1 ％,7/41) was lower than that in PKRP group (27.0％,10/17) (P =0.288).Conclusion PKEP is a safe and efficient treatment of BPH patients with prostate volume more than 80 ml.Compared with PKRP,PKEP provides less risk of hemorrhage and shorter catheter time,the operation time,irrigation time.
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Objective To observe the effect of a novel pressure controlled water jet used in transurethral resection of bladder tumor. Methods Clinical data of 12 patients who underwent a transurethral resection of bladder tumor by using a novel water jet was retrospectively analyzed. Results All 12 cases were successfully operated. Estimated blood loss during operation was less than 5 ml. Operation time was 20-45 minutes (median was 28 min), time of water injection was 8-15 minutes (median was 12 min). There were no significant complications. All patients were followed up for 4-10 months, and tumor recurrence or progression was not found by cystoscopic examination. Conclusion Transurethral resection of bladder tumor by using a novel pressure controlled water jet is advantageous with favorable safety and feasibility.
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PURPOSE: Transurethral surgery can cause an elevation of the total serum prostate- specific antigen (PSA); however, the effect on the free (PSA-F) and free-to-total PSA (f/t PSA) ratio is still unknown. The aim of this study was to investigate the effect of transurethral surgery on the serum total PSA (PSA-T), PSA-F and the f/t PSA ratio, in patients with benign prostatic hyperplasia (BPH) or a bladder tumor. MATERIALS AND METHODS: Thirty-five patients with BPH and 48 with a bladder tumor, who had undergone transurethral surgery, were included in this study. The serum PSA-T and PSA-F levels were determined before, and at 1 and 7 days after, the transurethral surgery, using an immunoradiometric assay. The Pre- and postoperative PSA-T, PSA-F and f/t PSA ratios were statistically compared. RESULTS: On the first postoperative day, the PSA-T and PSA-F levels increased significantly compared with the preoperative values (p0.05). In contrast, a mean 1.4-fold increase (29.13%) in f/t PSA ratio was noted 1 day after the TURP, but a mean 0.7-fold decrease (13.71%) was noted 7 day after, compared to preoperative mean value (20.24%). CONCLUSIONS: Both TURB and TURP caused an immediate increase in the serum PSA level, which was related to the resected volume of the prostate in the BPH patients. Our recommendation is that a serum f/t PSA ratio should not be obtained for at least 1 week after a TURP. For the purpose of improving the clinical availability of PSA, the f/t PSA ratio determination could be accurate and reliable following a TURB.
Subject(s)
Humans , Immunoradiometric Assay , Operative Time , Prostate , Prostate-Specific Antigen , Prostatic Hyperplasia , Transurethral Resection of Prostate , Urinary Bladder NeoplasmsABSTRACT
Objective To evaluate the effects of temperature of the irrigation fluid on body temperature and cardiovascular performance during transurethral surgery. Methods 87 cases were randomly divided into two groups according to the temperature of irrigation fluid used: the ambient (21～ 24 ℃) and the isothermic (35～36 ℃). Body temperature, blood glucose, ECG, HR, SaO 2, cardiac output (CO), mean arterial pressure (MAP) and systemic vascular resistance (SVR) were monitored during the transurethral surgery. Results Body temperature was decreased 2.1 ℃, MAP elevated, CO decreased and SVR increased in the ambient group, while body temperature was decreased only 0.3 ℃ and cardiac performance was maintained relatively stable in the isothermic group. Conclusions Hypothermia, resulted from the use of large amount of low temperature irrigation fluid during transurethral surgery has detrimental effects on body temperature and cardiovascular performance. Isothermic irrigation fluid would stablize the cardiovascular performance and so increases the safety of transurethral surgery.
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A clinical observation was made on 282 cases of transurethral surgery who had been admitted to the Department of Urology, Medical School, Jeonbug National University during the period from January 1978 to August 1982. The results were summerized as follows. 1. Among 1,618 in-patients, 282 cases were undertaken transurethral surgery. 2. The age distribution ranged from 21 years to 83 years, the most prevalent age was from 60 to 79. 3. The sex ratio, male to female was 5.9:1. 4. The disease distribution were 176 case in B.P.H., 9 Cases in prostatic ca., 6 cases in median bar, 13 cases in bladder tumor, 58 cases in ureteral stone, 113 cases in bladder stone and 5 cases in urethral stone. 5. The most common surgical type was transurethral resection of prostate in 191 (67.7%). 6. The average operating time was 43 minutes. 7. Postoperative complications were listed as: 3 cases in bladder rupture, 2 cases in incontinence, 1 case in dysuria, 1 case in epididymitis, 1 case of recurrence of bladder tumor and 2 cases which were impossible of removal of stone basket with stone. 8. The postoperative hospitalization was between 2 days and 10 days, 6.3 day in average.
Subject(s)
Female , Humans , Male , Age Distribution , Dysuria , Epididymitis , Hospitalization , Postoperative Complications , Recurrence , Rupture , Schools, Medical , Sex Ratio , Transurethral Resection of Prostate , Ureter , Urinary Bladder , Urinary Bladder Calculi , Urinary Bladder Neoplasms , UrologyABSTRACT
A clinical observation was made on 352 cases of transurethral surgery performed in the Department of Urology, Kyung Hee University hospital during the period from January 1, 1974 to June 30, 1980 The following results were obtained. 1) Among total 2980 endoscopically examined patients, transurethral surgery was performed on 352 cases (11.8%). 2) During the period, of 1220 patients operated, 352 patients were performed transurethral surgery, giving a rate 28.85% 3) The age was ranged from 3 to 85 years old and most favorable age was in 40 to 49 years old in 23.59%, The sex ratio, male to female, was 2:1. 4) The common diseases were ureter stone 101 cases (28.69), female chronic urethritis 75 cases(21.3%), bladder tumor 71 cases (20.17%), B.P.H. 36 cases (10.2%), bladder neck contracture 11 cases (5.7%) and bladder stones 11 cases (5.11%). 5) The common surgical procedure were T.U.R. 121 cases (34.37%), stone basket manipulation 101 cases (28.69%), transurethral electrofulguration 93 cases (26.42%), and litholapaxy 18 cases (5.11%). 6) Average operation time was 45.2 minutes. 7) Average duration of hospital stay after operation was 8.6 days. 8) The anesthetic methods were general 144 cases, spinal 132 cases, sedation and local anesthesia 76 cases. 9) The success rate of stone basket was 55%. 10) The post-operative complications were listed as: delayed bleeding (3 cases), hemolysis(1 case), acute epididymitis (1 case), acute pyelonephritis (1 case), severe urinary tract infection (1 case) and upward migration of the ureter stone (1 case).
Subject(s)
Aged, 80 and over , Female , Humans , Male , Middle Aged , Anesthesia, Local , Contracture , Epididymitis , Hemorrhage , Length of Stay , Lithotripsy , Neck , Pyelonephritis , Sex Ratio , Ureter , Urethritis , Urinary Bladder , Urinary Bladder Calculi , Urinary Bladder Neoplasms , Urinary Tract Infections , UrologyABSTRACT
A clinical observation was made on 352 cases of transurethral surgery performed in the Department of Urology, Kyung Hee University hospital during the period from January 1, 1974 to June 30, 1980 The following results were obtained. 1) Among total 2980 endoscopically examined patients, transurethral surgery was performed on 352 cases (11.8%). 2) During the period, of 1220 patients operated, 352 patients were performed transurethral surgery, giving a rate 28.85% 3) The age was ranged from 3 to 85 years old and most favorable age was in 40 to 49 years old in 23.59%, The sex ratio, male to female, was 2:1. 4) The common diseases were ureter stone 101 cases (28.69), female chronic urethritis 75 cases(21.3%), bladder tumor 71 cases (20.17%), B.P.H. 36 cases (10.2%), bladder neck contracture 11 cases (5.7%) and bladder stones 11 cases (5.11%). 5) The common surgical procedure were T.U.R. 121 cases (34.37%), stone basket manipulation 101 cases (28.69%), transurethral electrofulguration 93 cases (26.42%), and litholapaxy 18 cases (5.11%). 6) Average operation time was 45.2 minutes. 7) Average duration of hospital stay after operation was 8.6 days. 8) The anesthetic methods were general 144 cases, spinal 132 cases, sedation and local anesthesia 76 cases. 9) The success rate of stone basket was 55%. 10) The post-operative complications were listed as: delayed bleeding (3 cases), hemolysis(1 case), acute epididymitis (1 case), acute pyelonephritis (1 case), severe urinary tract infection (1 case) and upward migration of the ureter stone (1 case).